Nuclear Pharmacy

For the past six weeks (and four more to come) I am interning at a nuclear pharmacy in Raleigh NC. Nuclear Pharmacy is like any other pharmacy in the sense that doctor's write orders/prescriptions for doses and call or fax them in. Pharmacists and technicians prepare and draw the doses in syringes or vials and then package them to be sent to the site and administered to the patient. The key difference however is that all the drugs in the nuclear pharmacy are radioactive. They are used mostly for diagnostic testing (think treadmill stress tests for heart disease or special eggs for gastric emptying), but some doses are for therapy (iodine for overactive thyroid or strontium for pain in bone cancer patients).

In my first six weeks I have learned to elute (or hit) a medical nuclear generator to obtain the radioactive isotope we use for most of our drugs. I have learned how to draw doses, package them and check to make sure they are cold (not radioactive) so they may be shipped to our clients. I have learned quality control procedures to make sure our equipment is working properly and to make sure the drug kits were properly tagged with radioactivity so the clinic will get a good scan for the patient.

The biggest challenges I've faced so far are the hours and a generator shortage. The hours are from the middle of the night to the middle of the afternoon. They have four pharmacists that rotate weekly between the 2400, 0200, 0600, and 0900 shifts (I've been flip flopping between 0200 and 0600). I knew about the hours when I signed up for this, what I didn't know was how hard it was going to be to sleep during the day when I'd rather lay outside and read a book (I slept for 12 hours Friday night to make up for it -- given I'd been awake for 29 at that point).

The generator shortage was unexpected. Apparently there are only about 5 or 6 medical nuclear reactors in the WORLD (none of which are in the US) and 3 (three!) of them went out of service at the same time. One of them had a heavy water leak and will be shutdown for 3 - 8 months (or forever, they haven't decided), and the other two went down for routine maintenance. Basically our product was cut down to about 30 - 40% of what we were used to, but none of the clinics (or at least few of them) cut down on their patient loads. It has made for long drawn out days and stressful times trying to decide who gets what doses and when exactly they can have them. We're getting an extra generator tomorrow we weren't expecting, so things are looking up.